When doing an admission assessment of a client with a history of alcoholism, the most important factor(s) to assess is/are:

the presence of track marks.

whether the client has had previous treatment.

when the client last had a drink.

previous coping skills.

Answer and Explanation

Correct Answer : B,C,D

B. Knowing whether they have sought treatment previously can help in understanding their treatment history, what interventions have been tried, and their level of engagement with treatment services. It can also indicate whether they might benefit from continuing with previous successful interventions or trying new approaches.
C. This information provides crucial information about the client's current alcohol use and potential withdrawal risks. Understanding when the client last consumed alcohol helps in assessing the severity of their alcohol dependence, the potential for withdrawal symptoms, and the urgency of intervention.
D. Understanding the client's coping skills helps in developing a comprehensive treatment plan tailored to their needs. Clients with effective coping skills may have a better prognosis and be more receptive to certain treatment approaches, while those lacking coping skills may require additional support and skill- building interventions.
A. Track marks typically refer to visible signs of intravenous drug use, often associated with substances like heroin. While individuals with alcoholism may have comorbid substance use disorders, track marks specifically indicate a history of intravenous drug use, not alcoholism.

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Correct Answer is C

Explanation

C. This approach involves establishing clear and consistent rules and boundaries, which are crucial for managing antisocial behaviors. It helps to create a structured environment where the consequences of actions are predictable and reinforces the understanding of acceptable behaviors.
A. Encouraging the client to explore and address underlying emotions, including feelings of fear and inferiority, can be an important aspect of therapy and may help mitigate manipulative behaviors over time.
B. Antisocial personality disorder is associated with behaviors that violate social norms and the rights of others. Positive reinforcement for these behaviors would not address the underlying issues and may inadvertently reinforce harmful patterns of behavior.
D. Ignoring inappropriate behavior may reinforce the notion that manipulation is an effective means of achieving desired outcomes and may lead to further boundary violations.

A. assess the client's airway and breathing. B. assess the client's gag reflex. C. call the physician immediately. D. document this as normal findings and reassess in half an hour.

Correct Answer is A

Explanation

A. The client's lethargy and lack of response to verbal commands raise concerns about their level of consciousness and potential airway compromise. Assessing the client's airway and breathing involves ensuring that the airway is clear, assessing respiratory rate and effort, and monitoring oxygenation.
B. Assessing the gag reflex can provide additional information about airway protection. However, it should not delay assessment and intervention for airway and breathing concerns.
C. Contacting the physician may be necessary but it is not the priority nursing action in this situation. The nurse should first assess the client's airway and breathing to ensure their safety and stability.
D. The client's lethargy and unresponsiveness are not normal findings after an endoscopy and require immediate assessment and intervention. Delaying assessment and intervention could lead to serious complications, including respiratory compromise or airway obstruction.

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When doing an admission assessment of a client with a history of alcoholism, the most important factor(s) to assess is/are:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The intervention appropriate for a client who has been manipulating others and has a diagnosis of antisocial personality disorder is to:

Correct Answer is C

Explanation

The nurse is caring for a client after an endoscopy. The client is lethargic and not responding to verbal commands. The priority nursing action is to:

Correct Answer is A

Explanation

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